Apparatus for bloodless phlebotomy



Nov. 8, 1960 H. SELIGMAN 2, 5

APPARATUS FOR BLOODLESS PHLEBOTOMY Filed Feb. 28, 1956 a Sheets-Sheet 1INVENTOR.

HANS S E li M AN A TTORNE Y.

Nov. 8, 1960 H. SELIGMAN APPARATUS FOR BLOODLESS PHLEBO'IOMY 3Sheets-Sheet 2 Filed Feb. 28, 1956 EHI Nov. 8, 1960 H. SELIGMAN2,959,171

APPARATUS FOR BLOODLESS PHLEBOTOMY Filed Feb. 28, 1956 3 Sheets-Sheet 3IN V EN TOR.

HAN/S g E ILLIMAIJ you; Q W

United States Patent APPARATUS FOR BLOODLESS PHLEBOTOMY Hans Seligman,164 Main St., Groton, N.Y.

Filed Feb. 28, 1956, Ser. No. 568,320

Claims. (Cl. 128325) This invention relates to a novel apparatus for thetreatment of pulmonary edema.

Pulmonary edema, the accumulation of serum in the cellular tissue of thelungs, may be treated in various ways. Sedation, bloodless phlebotomywith tourniquets or with blood pressure cuffs, oxygen and mercurialdiuretics, and/ or digitalization are the measures most commonlyemployed, thus fairly standardizing the treatment of pulmonary edema.Although the beneficial results of bloodless phlebotomy have beenrecognized by the medical profession for a great number of years, therehave been no practical, and at the same time, exact methods ofperforming it, so that as a result, it is generally used as a last,rather than, a first resort. Undoubtedly, a great many lives may havebeen saved in the past, had this form of treatment for pulmonary edemabeen used promptly and efficiently.

Actual bloodletting, or phlebotomy, is rarely indicated, except for theoccasional patient with polycythemia vera, an excess of corpuscles inthe bloor. In the majority of patients, this type of treatment iscontra-indicated and may prove to be dangerous partly due to the factthat such a form of treatment is not immediately reversible. All othertreatments with respect to pulmonary edema vary according to thespecific needs of each patient.

As known to those familiar with the art, bloodless phlebotomy is thetemporary trapping of up to 800 ml. of blood in three extremities of thebody. This may be performed in two ways. In the first method,tourniquets are applied to three of the four extremities, and once everyfifteen minutes, one tourniquet is released and applied to the limb thathas been formerly free. The great disadvantages of this method areobvious. Every fifteen minutes the patient had to be disturbed forchanging the tourniquet. This is particularly a handicap when thepatient is located in an oxygen tent. It was necessary to apply thepressure of each tourniquet at the diastolic or just below the diastolicpressure so that the arterial flow into the extremities was not impededand that only the venous return was blocked off. The pressure exerted oneach of these tourniquets could not be gauged accurately. If it were toohigh, it would increase the circulatory disturbance; if it were too low,value of the treatment would be useless.

Furthermore, there was always the possibility of inducing local vasculardamage if a tourniquet were left in place too long under too muchpressure, particularly if these vessels have been damaged byatherosclerosis or other such vascular disease. It has been establishedthat the use of these tourniquets have led to major vascular occlusionsresulting in subsequent amputations.

The second method used in treating pulmonary edema is with bloodpressure cuffs. Although applying blood pressurecuffs with manometers isa definitely superior method, in spite of this fact, tourniquets used inrotation is the method most commonly used today. In the use of bloodpressure culfs, the pressure applied to each limb can be measured andmaintained accurately at its most effective level through the use of themanometers attached thereto. Furthermore, the pressure is applied over awide area so that the danger of thrombosis is minimized. However, theapplication of three separate sphygmomanometers (inflating them to theproper level) and having to carefully watch the three dials, all at thesame time, is so impractical and cumbersome, that this method, in spiteof its obvious advantages over the tourniquet method, has largely beenabandoned.

It is the main object of this present invention to make the treatment ofpulmonary edema, using the bloodless phlebotomy method, a more practicaland accurate method of treatment.

Another object of this apparatus is to reduce the equipment now in use,from three separate sphygmomanometers to one compact unit.

Another advantage of this device is that once the cuffs are in place onthe patient, he need not be moved or disturbed any more for inflating ordeflating the cuffs. This results in less work on the part of thedoctor, as well as more comfort assured to the patient.

Still another advantage of this novel device is the fact that pressurein all three cuffs is uniform and equal at all times and can be read ona single manometer attached to the new apparatus.

Another purpose of this invention is to provide a main valve whereby,after maintaining the desired pressure for approximately fifteenminutes, the handle is turned onefourth of the way to automaticallydeflate one of the cuffs and connect the pressure line to the culf thathad been formerly empty.

It is another object of this apparatus to provide a main valve which,when rotated every fifteen minutes and adequate pressure is maintainedin the cuffs, continues the treatment indefinitely and accurately, withno disturbance to the patient and with a minimum of nursing care.

The construction of the cuffs used with respect to this apparatus are ofa simple snap-on type so that they may be quickly attached to the limbsof the patient. Two extra length cuffs are provided for the thighswhereby a greater area of the body may be covered.

Because of the construction of this unit, through the window of ahandle, it may be seen which of the four cuffs is not inflated and inuse, thereby allowing the physician to recognize which limb may be usedin the case of intravenous medication. It also enables the physician toset the apparatus on, for example, left arm empty" if he wants to injectinto the left antecubital vein.

Another advantage of this novel apparatus is the provision of a smallvalve, through which use, the pressure in the cuffs may be reduced incase it has been accidentally raised to a higher degree than that calledfor. This valve may also be used for gradual decrease in culf pressureat the termination of the treatment.

This compact unit may be used continuously for more than twelve days andnights of treatment. The cost of the operation, that is the refilling ofthe tank with carbon dioxide, is approximately one dollar. The compactstructure enables the easy transporting of the apparatus; this portableapparatus may be used under varying circumstances in regard to location.

In accordance with the present invention, the bloodless phlebotomyapparatus consists chiefly of a cylinder containing a gas, such ascarbon dioxide, which is the source of power. A lever connected to thetank or cylinder regulates the outflow of the gas into the maindistributing valve. The gas pressure flowing through to the main valveis recorded on a manometer attached thereto. This gas is passed throughthe main valve into outlet tubes connected to inflatable cuffs attachedto limbs of the patient. A flat handle located on the top of the mainvalve is employed to inflate three of the four cuffs simultaneously inrotation. A Window, showing clearly which of the four cuffs is notinflated at the time, is located on this .handle. -A second valve,;-similar. to that,. used on a blood pressure pump,,is attached t -thecylinder .containing' the gas. This valve may be, openedif the pressurein the cuffs accidentally has been raised ,too high, or for a gradualdecrease in: the cuff pressure atft-he termination of the treatment.

Other objects and advantages of this present invention will be fully setforth in the following description and the novel features thereof willbe specifically defined by the appended claims,

Further references are made to the accompanying drawings in which:

Figure l is atop elevation in perspective of the bloodless phlebotomyapparatus.

Figure 2 is. a front elevation. illustrating the cooperation of thelever with the stop screw, the manometer and the main distributing valveat the top of line 44.

Figure 3 is a side elevation in cross section showing the maindistributing valve.

Figure 4 is a top elevation of the distributing valve with the handleremoved.

Figure 5 is a bottom view of the notch plate of a section of the valvetaken at line 5-5 of Figure 3.

Figure 6 is a side elevation and cross section showing the cone in thevalve and the springs which fit into the notches of the notch plate whenit is turned.

With reference being made to the drawings, as illus trated in Figure 1,an assembly board 96 is shown having a cylinder 1 filled with a suitablegas, such as carbon dioxide, attached thereto. The gas from the cylinder1 is fed into the inlet 21 through pressure reduction valve 100, andpressure release valve 2. Located on one end of the cylinder 1 is aspring attachment 7 which is connected to the lever 5 by suitable means8. In the same manner, and referring to Figure 2, the opposite end ofthe spring 7 is attached to the assembly board 96, The circular armextension 10 of the lever 5 is held in position around a disc 11 bymeans of a screw 9. A stop screw 6 for lever 5 is affixedto the assemblyboard 96 by suitable means 12. This stop screw 6prevents the full escapeof the gas located in the cylinder 1 into the inlet 21 leading to themain distributing valve 50. A Tent 14 in the inlet 21, as illustratedspecifically in Figures 1 and 2, joins a tube 15 which connects to themanometer 31, so that themanometer 31 may record the pressure on theline of the gas flowing from the outlet of the, cylinder 1, through theinlet 21, into the main distributing valve 50.

As illustrated in Figures 2 and 3, the inlet 21 is connected to thecylinder 1 and leads to the main distributing valve 50. The gas passingthrough the inlet 21 enters the main distributing valve 50 by means of apassage 22, in through the canal 23 and up into the chamber 24 locatedin the main distributing valve 50.

Before further'details will be given With respect to the work of themain distributing valve 50, its construction will be explained. Thehandle 41 of the-main distributing valve 50 has a View opening 40. Awindow plate 83 is connected to a notch plate 84 by means of screw 82,as shown in Figure 3. A cone 91 is held in position through its stem 92which passes up through the notch plate 84 and the window plate Y83, andis aflixed onto the handle 41 by means of a screw 93.

With reference now to Figures 3, 5, and 6, a spring 61 exerts tension onthe notch plate 84 so that, as the handle 41 of the main distributingvalve 51!, is turned, the clovershaped recesses 74 hold the cone 91 ofthe valve 50 in position, with respect to the entrance of the gastherein into the cuffs.

As the gasv entersthe chamber .24 in the main dis- Iibuting valve,.50,-itpasses through the threeopenpas-v sageways 25 into the valve outlets26 which lead by means of suitable tubing 10 into the inflatable cuffs(not shown), located on the limbs of a patient. In this setting of themain distributing valve 50, one passageway, here designated by thenumeral 29 is connected to the atmosphere (the opening not being shown).As the handle 41 of the main distributing valve 50 is rotated, one ofthe four valve outlets 26leading to the inflatable cuffs, is closed bymeans of the clover-shaped recesses 74 holding the cone, 91 on position,and connects this valve to the atmosphere as is valve 32, shown inFigure 3.

In the operation of this bloodless phlebotomy apparatus, the cuffs,identical with those used with a blood pressure recording machine, areplaced one on each thigh and upper arm of the patient. The maindistributing valve 59 on this apparatus is set so that the gas entersonly three of the four cuffs located on the patient; that is, the handle41 with the view opening 40 is placed with respect to the window plate83 sothat the cuff not being inflated is seen, as illustrated in-Fig-ure1, the left leg cuff being the one that is blocked off. With the settingof the handle 41, the clover-shaped recesses hold the valve 50 inposition. The lever 5 is pressedallowing the flow of the gas from thecylinder 1 to enter the inlet 21. As the gas passes throughthe inlet 21,the pressure is recorded on the manometer 31 attached thereto, allowingthe operator to see the amount of pressure entering through the maindistributing valve 50, into the three open valves leading to theinflatable cuffs. The pressure is applied to the three extremities ofthe patients limbs that are contacted by the inflated cuffs. As it isdesired to change the pressure on the limbs of the patient at each 15minute interval, by'turning the handle 41 in rotation, each of theyfourcuifs will receive the pressure, one of which at all times will beempty.

In treating various cases, for example, in the case of mitral stenosis,extreme activity causes a damming upof blood behind the mitral valve. Inthis disease, the pressure in the left atrium rises and the bloodcontent of the lungs increases, causing some congestive failure withdyspenea and an abnormally long period of tachycardia. Over a period oftime, increased pressure in the left auricle results in enlargement ofthis chamber. which is demonstrable by roentgenography. This presentinvention cuts down the amount of blood pumped from'the lungs out intothe right heart, so. that. the left heart can catch up with it and thefluid in the lungs will decrease. In this manner, the inflow and outfloware kept equal, so that the blood located in the lungs accounts forabout 6 percent of their total volume, as is found in a normal heartfunction. I l V I I Caution is to be practiced in operatingthe-handle-of the valve, making sure that the handle is set leaving onecuff open to the atmosphere.v Otherwise, the pressure from the cylinderwill be brought to bear on the manometer.

While certain novel featuresof the invention have been disclosed and arepointed out in the annexedvclairns, it will be understood that variousomissions, substitutions and changes may be made by those familiar inthe art without departing from the spirit of the invention.

I claim:

1. A bloodless phlebotomy apparatus comprising a reservoir containinggas under pressure, an outlet from said reservoir, a main distributingvalve and an inlet thereto connected to said outlet, a pressure releasevalve in said outlet forming means for regulating the. flowiof said gasfrom said reservoir to said inlet, a manometer attached to said inlet,valve outlets from said-main distributing valve and four inflatablecuffs connected thereto, said main distributing valve forming means forthe alternate application of pressure simultaneously into three of saidfour inflatablecuffs.

2. A bloodless phlebotomy apparatus comprising in combination a cylindercontaining a gas under pr e ss 1pe and an outlet therefor, a maindistributing valve and an inlet thereto connected to said outlet formingmeans for passage of said gas from said cylinder to said distributingvalve, a manometer connected to said inlet for registering the pressureof said gas passing through said inlet, a pressure release valve forregulating the flow of gas into said inlet, valve outlets connected tosaid main distributing valve and four inflatable cuffs connectedthereto, said distributing valve comprising means for distributing saidgas through three open outlets thereof and inflating three of said fourcufi's uniformly and simultaneously for the purpose of regulating theflow of the blood pumped to the lungs of a patient, said pressurerelease valve forming means for reducing pressure in said cuffs when thepressure is accidentally raised to a higher degree than that called for,said release valve also means for a gradual decrease in the cufl.pressure at the termination of the treatment.

3. A bloodless phlebotomy apparatus comprising a cylinder containing asuitable gas under pressure, an outlet located at one end of saidcylinder, a lever arrangement and a pressure reduction valve operatedthereby, a pressure release valve located in said outlet forming meansfor reducing the pressure in the inflatable cuffs and for reducing thepressure at the termination of the treatment, a main distributing valveand inlet therefor connected to said outlet forming means for thepassage of gas into said main distributing valve, a manometer attachedto said inlet, said manometer forming means for registering the pressurethrough said inlet into said main distributing valve, valve outlets onsaid main distributing valve and four inflatable cuffs connected theretoby suitable means, said main distributing valve comprising means fordistributing the gas from said cylinder through three open outlets ofsaid four outlets and inflating three of 30 the said four inflatablecufls uniformly and simultaneously for the purpose of regulating theflow of the blood pumped to the lungs of a patient.

4. Bloodless phlebotomy apparatus including a main distributing valve,and four inflatable cuffs attached to the limbs of a patient for thepurpose of applying pressure thereto and regulating the blood pumped tothe lungs of the patient, said main distributing valve having an inletto a chamber and four valve outlets connected to said chamber, saidcufls being connected to said outlets, and means for distributing gaspressure from said inlet into any three of said four outlets, wherebyany three of the said four inflatable cuffs are inflated and a fourthcuff is vented to the atmosphere.

5. A main distributing valve for regulating the gas pressure from aninlet to three of four valve outlets, and four inflatable cufls attachedto the limbs of a patient for the purpose of applying pressure theretoand regulating the blood pumped to the lungs of the patient, said maindistributing valve having an inlet to a chamber and four valve outletsconnected to said chamber, said main distributing valve forming meansfor distributing gas pressure from said inlet into any three of saidfour outlets, said cuffs being connected to said outlets, said maindistributing valve having a handle with a view opening therethrough anda window plate, said window plate having means for designating which ofthe four inflatable cufis is empty and which three of the fourinflatable cufis are inflated, last said means being formed with respectto said view opening in said handle, said main distributing valvethereby forming means whereby any three of the four inflatable cults areinflated and the fourth cuff is blocked off and vented to theatmosphere.

References Cited in the file of this patent UNITED STATES PATENTS2,335,085 Roberts Nov. 23, 1943 2,345,073 Rosett Mar. 28, 1944 2,533,504Poor Dec. 12, 1950 FOREIGN PATENTS 159,922 Great Britain Mar. 7, 1921

